Pituitary adenoma is a benign adenoma that is quite common, with about one case in 100,000 people, and has been increasing in recent years, especially in women of childbearing age.
Clinical manifestations
The pituitary gland is an important endocrine organ, containing several types of endocrine cells that secrete a variety of endocrines. The details are described as follows.
1. Endocrine manifestations of different types of pituitary adenomas
(1) Growth hormone cell adenoma: In the early stage, the tumor is only a few millimeters in size and mainly shows excessive secretion of growth hormone. In adolescent patients, excessive growth may occur, and the patient may even develop into a giant. As an adult, the tumor may show signs of hypertrophy of the extremities. Some patients have increased food intake, rough hair and skin, pigmentation, and numbness of fingers. In severe cases, the patient may feel general weakness, headache and arthralgia, hypogonadism, amenorrhea and infertility, and even diabetes.
(2) Prolactin cell adenoma: The main manifestations are amenorrhea, overflow of milk, infertility, axillary hair loss, pale and delicate skin, increased subcutaneous fat, weakness, fatigue, drowsiness, headache, and hypogonadism. In men, the symptoms include decreased libido, impotence, breast enlargement, beard thinning, atrophy of the reproductive organs, decreased sperm count, and infertility, etc. There are not many male and female changes.
(3) Adrenocorticotropic adenoma: Clinical manifestations include centripetal obesity, full-moon face, buffalo back, polycythemia, purple lines on the skin of abdomen and thighs, and increase in fine hair. In severe cases, amenorrhea, loss of libido, general weakness, and even bedridden. Some patients also have hypertension and diabetes mellitus.
(4) Thyroid-stimulating hormone tumor: Rarely, hyperthyroidism is caused by overproduction of thyroid-stimulating hormone in the pituitary gland. The symptoms of hyperthyroidism disappear after removal of the pituitary tumor. There are also cases of focal hyperplasia of the pituitary gland due to hypothyroidism feedback, which gradually develops into pituitary adenoma.
(5) Follicle-stimulating hormone cell adenoma: Very rare, only a few reports of clinical hypogonadism, amenorrhea, infertility, sperm count reduction, etc.
(6) Melanin-stimulating hormone adenoma: Very rare, only a few patients reported black skin pigmentation without cortisol increase.
(7) Endocrine inactive adenoma: In the early stage, the patient does not have any special feeling that the tumor is growing, and it may compress the pituitary gland and cause clinical manifestations of pituitary insufficiency.
(8) Malignant pituitary tumor: short history, rapid progression of the disease, not only the tumor grows to compress the pituitary tissue, but also invades the surrounding area, causing destruction of the bone of the saddle base or infiltration into the cavernous sinus, resulting in actinic nerve paralysis or abducens nerve paralysis. Sometimes the tumor penetrates the saddle base and grows into the pterygoid sinus, but the neurological symptoms are not obvious for a short period of time.
2.Visual field disorder: Early pituitary adenoma often has no visual field disorder. If the tumor grows up and extends upward, compressing the optic fork, visual field defect will appear, the outer upper quadrant will be affected first, and the red field will be the first to show. If the tumor grows and compresses the optic fork, the visual field defect will appear. If left untreated, the visual field defect may expand further and the visual acuity may be diminished, leading to total blindness. Because pituitary tumors are mostly benign, the initial lesions can last for a considerable period of time, but when the condition becomes severe, the visual field impairment can suddenly increase, and if the tumor is on one side, it can lead to monocular blindness or blindness.
3. Other neurological symptoms and signs: if the pituitary tumor grows posteriorly and presses the pituitary stalk or hypothalamus, it may cause excessive drinking and urination. If the tumor grows posteriorly and obstructs the anterior part of the third ventricle and interventricular foramen, headache, vomiting and other symptoms of increased intracranial pressure may occur.
Clinical manifestations of pituitary tumors Pituitary tumors mostly occur in young adults aged 20 to 50 years old, but are rare in the elderly, especially in children, with roughly equal incidence in men and women. The clinical manifestations may be one or more of the following: 1. Headache. Visual field changes (unclear vision in one or both eyes, easy to hit the door frame, progressive blindness in severe cases or sudden headache blindness) 3. Menstrual disorders, menopause, lactation (spontaneous milk flow from the breast or milk flow after touching the breast), inability to conceive, changes in libido sexual ability (mostly hypogonadism), reduction in body hair, skin changes (thinning) 4. Acromegaly: hands and feet, head, thorax and limbs Progressive enlargement, hypertrophy of the palms of the hands and feet, thickening of the fingers, spherical distal end, bulging forehead, orbits, cheekbones, i.e., jaws, significantly protruding, widening of the teeth, thickening of the lips, wide and flattened nasal bridge, large ears, hats, shoes and socks, gloves often
Auxiliary examination
1.Endocrinological examination: The growth hormone, prolactin, adrenocorticotropic hormone, thyroid-stimulating hormone, melanin-stimulating hormone, follicle-stimulating hormone and luteinizing hormone of pituitary gland are directly measured by endocrine radioimmunoassay.
2.Radiological examination
(1) Pterygoid saddle image: It is one of the basic examinations. When the pituitary tumor is small, there may be no change in the saddle.
(2) CT scan: After enhancement with intravenous contrast, it can show pituitary adenoma of 5mm in size. Smaller tumors are still difficult to show.
(3) MRI scan: MRI plain scan and enhanced scan can clearly show the size of tumor and the relationship with surrounding tissues. MRI scan can diagnose most pituitary adenomas and provide important information for the selection of surgical plan.
Treatment
1.Surgical treatment: mainly includes craniotomy and transsphenoidal sinus surgery.
2.Radiotherapy: general radiotherapy has some effect on pituitary adenoma, but it can only control the development of tumor, sometimes make the tumor shrink, resulting in the improvement of visual field, but it cannot cure fundamentally; only head gamma knife treatment is the radical cure of pituitary tumor.
3.Medication: Bromocriptine is a semi-synthetic ergotamine alkaloid, which can stimulate the dopamine receptors of pituitary cells to reduce the effect of prolactin in blood. Bromocriptine can reduce the size of prolactin adenoma, restore menstruation and ovulation and conception, and suppress pathological overflow of breast milk. In addition, bromocriptine can also reduce the symptoms of growth hormone cell adenoma, but the dosage of the drug is large and the efficacy is poor.